This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Poulter, N. Search for Related Content PubMed Articles by Poulter, N. Social Bookmarking                         What's this?

Are current therapies for hypertension achieving their goal?

International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK, n.poulter{at}imperial.ac.uk

The majority of adults with hypertension do not get their blood pressures controlled to currently recommended targets, despite relatively consistent blood pressure targets in guidelines from around the world. This requires major preventative and treatment strategies to be implemented both in the general population and in the hypertensive population. The reasons behind the failure to achieve blood pressure targets are many and varied and include physician inertia, ineffective drugs, poor patient compliance, side-effects and poor communication of guidelines. Physician inertia is perhaps the most important contributor to under-treatment. The recent A/CD algorithm in guidelines co-produced by the British Hypertension Society and the National Institute for Health and Clinical Excellence in the UK and Ireland provide a memorable, pragmatic and logical approach to guide drug sequencing with a view to achieving blood pressure targets for most patients.

Key Words: antihypertensive agents • blood pressure control

References

• Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• MacMahon S., Peto R., Cutler J. et al. Blood pressure, stroke, and coronary heart disease. Part I, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335:765-74.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Lewington S., Clarke R., Qizilbash N. et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Williams B., Poulter N., Brown M. et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society 2004-BHS IV. J Human Hypertens 2004;18:139-85.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Guidelines Committee. 2003 European Society of Hypertension - European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003;21:1011-53.
• Chobanian AV, Bakris GL, Black HR et al. and the National High Blood Pressure Education Programme Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003;289:2560-72.[Abstract/Free Full Text]
• Vasan RS, Larson MG, Leip EP et al. Impact of high-normal BP on the risk of cardiovascular disease. New Engl J Med 2001;345:1291-7.[Abstract/Free Full Text]
• Mancilha Carvalho JJ, Baruzzi RG, Howard PF et al. Blood pressure in four remote populations in the INTERSALT Study. Hypertension 1989;14:238-46.[Abstract/Free Full Text]
• Primatesta P., Poulter NR Hypertension management and control among English adults aged 65 years and older in 2000 and 2001. J Hypertens 2004;22:1093-8.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Wolf-Maier K., Cooper RS, Kramer H. et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 2004;43:10-17.[Abstract/Free Full Text]
• Dahlof B., Sever PS, D Poulter NR et al. for the ASCOT investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BLOOD PRESSURE LA): a multicentre randomised controlled trial. Lancet 2005;366:895-906.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• NHS, NICE clinical guideline 18. Hypertension: management of hypertension in adults in primary care. Issue date August 2004.
• NHS, NICE clinical guideline 34. Hypertension: management of hypertension in adults in primary care. Partial update of NICE clinical guideline 18: Prescribing drugs section updated by the British Hypertension Society and National Collaborating Centre for Chronic Conditions. Issue date: June 2006. ISBN 1-84629-222-0.
• Law MR, Wald NJ, Morris JK, Jordan RE Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. Br Med J 2003;326:1427.[Abstract/Free Full Text]
• Primatesta P., Brookes M., Poulter NR Improved hypertension management and control. Results from the Health Survey for England 1998. Hypertension 2001;38:827-32.
• Primatesta P., Poulter NR Improvement in hypertension management in England: results from the Health Survey for England 2003. J Hypertens 2006;24:1187-92.
• Okonofua EC, Simpson KN, Jesri A., Rehman SU, Durkalski V., Egan BM Therapeutic inertia is an impediment to achieving the healthy people: 2010 blood pressure control goals. Hypertension 2006;47:345-51.[Abstract/Free Full Text]
• The ALLHAT Officers and Co-ordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid Lowering treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981-97.[Abstract/Free Full Text]
• Julius S., Kjeldsen SE, Weber M. et al. for the VALUE trial group. Outcomes in hypertensive patients at high cardio-vascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 2004;363:2022-31.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Mancia G., Grassi G. Systolic and diastolic blood pressure control in antihypertensive drug trials. J Hypertens 2002;20:1461-4.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

Journal of Renin-Angiotensin-Aldosterone System, Vol. 7, No. 2 suppl, S3-S6 (2006)
DOI: 10.3317/jraas.2006.034


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Poulter, N. Search for Related Content PubMed Articles by Poulter, N. Social Bookmarking                         What's this?